Nepal’s 2011 Demographic and Health Survey Shows TFR Decline, But Lagging Progress

by Carl Haub, senior visiting scholar

With this post, I’ll begin giving brief summaries of surveys that update important variables such as the total fertility rate (TFR), infant mortality, contraceptive use, etc. Surveys can be used to track just how countries are doing and to check their progress against population projections that we all use. The most recent Demographic and Health Survey (DHS) is the 2011 DHS of Nepal. This DHS was released after we finalized PRB’s 2011 World Population Data Sheet so it provides an update. Long-time followers of PRB may remember that this was done in our printed newsletters in the past.

Photo: Creative Commons/ngotoh

The Nepal 2011 DHS interviewed 12,674 women and 4,121 men ages 15 to 49. The total fertility rate (TFR — the average number of children would bear in her lifetime if the birth rate of a particular year were to remain constant) obtained in the survey was 2.6 for the three-year period preceding the survey. For urban women, the TFR was 1.58 and, for rural women, 2.78. Rural women made up 83 percent of the sample. The TFR has declined steadily in Nepal from 6.3 in the World Fertility Survey conducted in 1976, with the largest recent decrease in survey TFRs from 4.1 in the 2001 DHS to 3.1 in the 2006 DHS. Of currently married women with two living children, 65.7 percent said that they wanted no more and an additional 22.3 percent of those with two children had been sterilized. Only very small percentages with two or more living children said that they wanted another child “soon” or “later.”

Nearly half of currently married women said that they were using some type of contraception at the time of the survey (49.7 percent) and 43.2 percent were using a modern method (including the pill, female and male contraception, IUD, injection, implants, and condoms). The leading three modern methods use were female sterilization (15.2 percent), injectables (9.2 percent), and male sterilization (7.8 percent). There was a decrease in modern contraceptive use from the 2006 DHS when it was 44.2 percent and more emphasis has been place by the government on long-term temporary methods and male sterilization.

Among births in the past five years, 58.3 percent of women had antenatal care from a skilled provider (doctor, nurse, or midwife) but only 36 percent of deliveries were attended by a skilled provider and only 28.1 percent took place in a health facility. That is well short of the 60 percent target set by the UN Millennium Development Goals for deliveries in a facility for 2015. These proportions have increased since the 2006 DHS, however. Among the most recent births, 76.9 percent were protected against neonatal tetanus, but that has remained unchanged since the 2006 DHS. All of these measures were the highest in the Terai, or lowland zone bordering India where a little over half of Nepalese live, compared with the Mountain and Hill zones.

Childhood mortality has been declining slowly. The infant mortality rate in the five years before the survey decreased to 46 infant deaths below age one per 1,000 live births from 60 five to nine years before the survey. The current level is similar to that in India. Mortality under age 5 showed a similar decline. Nepal has a ways to go on child nutrition. The survey found that 40.5 percent of children had stunted growth, 28.8 percent were underweight, and 10.9 percent were wasted (weight-for-height).

Nepal’s 2011 DHS indicates that the country is well on the way to achieving replacement fertility and that TFR decline has been steady from survey to survey. But progress on other measures still lag behind.

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